Provider First Line Business Practice Location Address:
305 COSBY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-623-7116
Provider Business Practice Location Address Fax Number:
423-623-5743
Provider Enumeration Date:
10/31/2006